食管旁疝通常无症状,但当出现症状时,应通过腹腔镜固定。进行膈柱的锁骨成形术,通常在那时进行胃底折叠术。然而,有些时候,尤其是在紧急情况下,在那里并不总是可以进行胃底折叠术。我们假设是否将胃底折叠术作为食管旁疝修补术的一部分,结果没有差异。
使用PubMed,临床密钥和谷歌学者。我们的搜索条件是:\"食管旁疝\"\"食管旁疝修复\"\"胃底折叠\"\"急诊手术\"\"没有胃底折叠\"我们排除了英语以外的其他语言的研究,摘要和小案例系列。
我们的搜索标准在1997年至2020年期间共发表了22项研究。共有8600名受试者参加了这项研究。胃底折叠术的总体汇总患病率估计为69%(95%CI:59%-78%)。在接受胃底折叠术的患者中,与未进行胃底折叠术的患者相比,胃食管反流病(GERD)的风险降低(RR:0.64,95%CI:0.40~1.04,p=0.069,I2=47.2%).在复发(RR:0.53,95%CI:0.27-1.03,p=0.061,I2=0.0%)和再次手术(RR:0.25,95%CI:0.02-2.69,p=0.25,I2=56.7%)中也观察到类似的趋势。然而,接受胃底折叠术的患者发生吞咽困难的风险增加(RR:1.68,95%CI:0.59~4.81,p=0.83,I2=42%).
胃食管反流病的复发率较高,当食管旁疝修补术期间未进行胃底折叠术,但吞咽困难的风险较低时,疝复发和再次手术,但是这些都没有达到统计学意义。(评论1)应进行食管旁疝修补术与胃底折叠术,但是在某些情况下不这样做是可以接受的。
Paraesophageal hernias are often asymptomatic, but when symptomatic they should be fixed laparoscopically. A cruroplasty of the diaphragmatic pillars is performed and a fundoplication is usually performed at the time. However, there are times, especially in emergency cases, where it is not always possible to perform a fundoplication. We hypothesized there would be no difference in outcomes whether or not a fundoplication is performed as part of a paraesophageal hernia repair.
A literature
review of available clinical databases was performed using PubMed, Clinical Key and Google Scholar. Our search terms were: \"paraesophageal hernia\" \"paraesophageal hernia repair\" \"fundoplication\" \"emergency surgery\" \"no fundoplication\" We excluded studies that were in languages other than English, abstracts and small case series.
Our search criteria yielded a total of 22 studies published between 1997 and 2020. There were a total of 8600 subjects enrolled into this study. The overall pooled prevalence of fundoplication were estimated as 69% (95% CI: 59%-78%). In patients who underwent fundoplication, the risk of gastroesophageal reflux disease (GERD) was reduced as compared to patients who did not undergo fundoplication (RR: 0.64, 95% CI: 0.40-1.04, p = 0.069, I2 = 47.2%). A similar trend was also observed in recurrence (RR: 0.53, 95% CI: 0.27-1.03, p = 0.061, I2 = 0.0%) and reoperations (RR: 0.25, 95% CI: 0.02-2.69, p = 0.25, I2 = 56.7%). However, patients who underwent fundoplication had an increased risk of dysphagia (RR: 1.68, 95% CI: 0.59-4.81, p = 0.83, I2 = 42%).
There is a higher rate of recurrence of gastroesophageal reflux disease, recurrence of hernia and reoperation when no fundoplication is performed during a paraesophageal hernia repair but a lower risk of dysphagia, but none of these reached statistical significance.(Comment 1) Paraesophageal hernia repair with fundoplication should be performed, but it is acceptable to not do it in certain situations.